Patient, Public & Media Information

Affordable Care Act (ACA)

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA). The intent of the ACA is to expand health insurance coverage while also reforming the health care delivery system to improve quality and value. It requires U.S. citizens and legal residents to have health insurance and creates exchanges through which individuals and small businesses can purchase coverage.

The American Association of Orthopaedic Surgeons (AAOS) believes health care policy should empower patients to control and decide how their health care dollars are spent, ensure unencumbered access to specialty care, make health care coverage more affordable, and improve quality of care. While some provisions of the ACA are in line with the principles of health care reform promoted by the AAOS, other portions remain problematic and continue to raise concerns that the law may result in less access to care and less care being provided. AAOS will continue to fight for changes that improve health care for our patients and address the concerns of our members.

IPAB: The ACA created the Independent Payment Advisory Board (IPAB) to "reduce the per capita rate of growth in Medicare spending." The IPAB is set to include 15 unelected, unaccountable members with none of those members allowed to be practicing physicians or be otherwise employed. AAOS opposes the IPAB. Click here for more information on IPAB.

CMMI bundled payment programs: The Center for Medicare and Medicaid Innovation (CMMI) was established through the ACA with the purpose to test "innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. Recently, CMMI introduced several mandatory payment models, including the Comprehensive Care of Joint Replacement Program (CJR). AAOS is strongly opposed to mandatory demonstrations and has urged CMS to instead test voluntary payment and delivery models over smaller geographic areas. Click here for more information on bundled payment programs.

Physician-owned hospital restrictions: Section 6001 of the ACA included a provision that strictly prohibits any new physician-owned hospital from participating in Medicare or Medicaid. Furthermore, the ACA also prohibits existing physician-owned hospitals from expanding unless they meet a very complicated set of criteria as part of a long application process. These hospitals provide some of the highest quality care in the country and the current prohibition undermines the ACA’s goal of increasing access to quality health care. Click here for more information on physician-owned hospitals.